For years, pediatricians have faced a growing dilemma. Families increasingly turn to primary care for help with mental health concerns, yet many pediatricians feel underprepared, and child psychiatrists remain in short supply.
More than a decade ago, University of Michigan Health tried a different approach: bringing child psychiatry directly into the pediatric medical home and embedding it into pediatric resident training.
The result was the Pediatric Psychiatry Colocalized Consult Clinic, or P2C3, a model designed to improve access to care while training future pediatricians to manage common mental health conditions.
Newly reported outcomes from the clinic, published in the journal Psychiatric Services , show the approach worked. The program proved durable, scalable and beneficial for both patients and pediatric physicians.
"Pediatricians are increasingly on the front lines of children's mental health care, often without enough training or specialist support," said lead author Margeaux Naughton, M.D., pediatrician at U-M Health C.S. Mott Children's Hospital .
"This clinic was built around the conditions pediatricians see every day. By embedding psychiatric expertise within primary care, we're able to respond more quickly to mental health concerns, keep more patients within their medical home, and foster collaboration between pediatricians and psychiatrists for the best possible outcomes"
Building mental health care into the medical home
P2C3 launched with an eight-month pilot in 2013 within an academic pediatric primary care clinic. The concept was simple: pediatric residents would see patients alongside a child and adolescent psychiatrist in the same clinic space, learning mental health care through direct, supervised practice. After consultation and management of their mental health conditions in the clinic, appropriate patients would be transitioned back to their primary care physician for continued management.
During the pilot, the clinic served 66 patients with a mean age of 12.7 years; 30% were covered by Medicaid. New patients were typically seen within one to three weeks of referral, far faster than typical psychiatric wait times.
The most common conditions reflected what pediatricians encounter every day. Attention-deficit hyperactivity disorder was diagnosed in 45% of patients, depression in 32% and anxiety in 29%.
Training that builds confidence
Beyond patient care, the clinic was designed as a teaching model emphasizing observation, direct feedback and hands-on clinical experience.
Thirty-seven pediatric residents participated during the pilot and completed surveys before and after the rotation assessing their knowledge and comfort managing pediatric mental health conditions.
Residents reported greater confidence diagnosing and treating common conditions, including depression and anxiety, and improved comfort with initial treatment strategies.
"Residents weren't just observing psychiatry," said Joanna Quigley, M.D., U-M Health child and adolescent psychiatrist. "They were actively participating in care with support, which makes a difference when they carry these skills into independent practice."
Following the successful pilot, the clinic became a permanent part of the health system.
Over the last decade, P2C3 has completed more than 1,500 visits and cared for over 400 patients, from early childhood through young adulthood. Hundreds of pediatric residents have benefitted from this innovative mental health training.
The goal, authors say, is to help get pediatric patients expert psychiatric support to stabilize their mental health conditions while empowering pediatricians to continue managing care.
The need remains urgent. The United States continues to face a severe shortage of child and adolescent psychiatrists, even as pediatricians are increasingly asked to manage complex mental health concerns.
"Families value knowing their child's mental health care is connected to their primary care team," Naughton said. "This model reduces fragmentation and provides both timely access for patients and lasting skill-building for physicians. With primary care and psychiatry working hand-in-hand, we're bringing mental health care access for our patients and preparing the next generation of pediatricians to meet these challenges head-on."
